Testing a novel method for measuring sleeping metabolic rate in neonates

Abstract

BACKGROUND: Sleeping metabolic rate (SMR) is used as a proxy for basal metabolic rate in infants, when measurement while awake is not practical. Measuring SMR via indirect calorimetry (IC) can be useful for assessing feeding adequacy especially in compromised neonates. Standard IC equipment, including a hood placed over the head, is not designed for the smallest of patients. Our aim was to determine whether a nonstandard smaller hood measures SMR in neonates similarly compared with a standard large hood. METHODS: SMR was measured in healthy neonates (controls) and those born with single-ventricle congenital heart disease (cases). Two measurements were performed: SMR using a standard larFĒCO 2 ge hood and SMR using a smaller hood. Time-to-steady state, minute ventilation (V̇ E), and fraction of exhaled carbon dioxide (F ECO 2 ; an indicator of data quality) were also measured. Primary outcome was SMR using both hoods. Results are stated as median (interquartile range). Spearman's correlations measured association between the small and large hoods. RESULTS: We studied 9 controls and 7 cases. SMR in controls was not different between the small and large hoods (35.7 [15.14] vs 37.8 [7.41] kcal/kg/d, respectively). In cases, SMR with the small hood was significantly greater than that with the large hood (45.5 [4.63] vs 34.2 [8] kcal/kg/d, P < .02). ECO 2 was significantly higher with the small hood versus the large hood in both groups, and V̇ E was significantly lower with the small hood versus the large hood in controls only. The SMRs with the small and large hoods were significantly correlated in the control group (r = 0.80, P < .01). Time-to-steady state was similar in both groups regardless of hood size. CONCLUSIONS: SMR measured with a small hood yields results similar to those measured with a large hood in healthy neonates without affecting testing time or other aspects of the IC procedure. Furthermore, results in compromised infants suggest that a smaller hood may facilitate SMR testing in this population.